78054A_Marlow, Patricia_20210211

CAMA / E7 DREDGE & FILL N9 78054 A B C D
GENERAL PERMIT Previous permit#
INew El Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC f `tA ,), � O O
Rules attached.
Applicant Name Jlc i w, c� G A. Ko r I u hJ
Address $34O 54on.t F1cr.'7c- j,& i2�
City - A, aA1e'rcx Stated ZIP aITSI
Phone # (19%) g!M- 433t E-Mail
Authorized Agent
Affected ❑ CW 'XEW IPTA IXl ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /& PNA yes / no
Project Location: County I e r4
Street Address/ State Road/ Lot #(s)
I 1 � \,VCb1-, Si. , j i # Li
Subdivision
City 4-leC\ ZIP d4944
Phone # ( ) River Basin c cry IC
Adj. Wtr. Body Mal me / j c So n at, man /unkn)
Closest Maj. Wtr. Body A I Vc t.,` r l< So � ^ c'
Type of Project/ Activity �c ti le, cif i F bu ► Kl ct, cl
(Scale: N,. T. 5► )
Flier I
Fixec
Float
Finge
Groii
$urkt
Basin
Boat
Boatl
Beac
Othe
Shon
SAV:
Morz
Phot
Waiv
A building permit may be required by: pe iu,...lne. r+ 5 C`v .r� `/ ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
f
Agent or nt Printed N me
Signature * Please read compliance statement on back of permit"
14Co Oo #yySa.
Application Fee(s) Check #
PermitOff Name
L-Stgnature
dJd.1
Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888ARCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: p "') 4) 1 C o i
Phone Number: 856 889 4337
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development. -
TO CONSTRUCT 100/FT REPLACEMENT BULKHEAD
at my property located at. 115 VVEBB ST, HE=RTFORD N.0
in Pelrl . is aaats County.
I furthermore certify that l am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
7*�
!i , ✓xlr/".f"f>"f
Signature
41
Print or Type Name
Title
Date
This certification is valid through I_ I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT RECEIVED
I hereby certify that I own property adjacent to ' P - ' s 0 g 2021
(Name of Property Owner) FEB
property located at 115 WEBB ST, HERTFORD N.0
(Address, Lot, Block, Road, etc.) � /�_CC
on ALBEMARLE SOUND , in HERTFORD N.CCg G
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
L-� I have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
TO CONSTRUCT 100/FT REPLACEMENT BULKHEAD
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement_
(Property Owner Information) (Adjacent Property Owner Information)
Signature Signature
Print or Type Name Print or Type Name '
Mailina Address �— Marling Address
City/State/Zip City/State/Zip e L -7 t
856 889 4337
Telephone Number/email address Telephone Number/email address
Lq -d�)
Date Date*
(Revised Aug. 2014)
;Valid for one calendar year after signature*

RECEIVED
I hereby certify that I own property adjacent to - s
(Name of Property Owner) FEB 0 9 2021
property located at 115 WEBB ST HERTFORD N.0
(Address, Lot, Block, Road, etc.)
on ALBEMARLE SOUND in HERTFORD N.0 tD.CM-EC
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
r/ I have no objection to this proposal.
i have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
TO CONSTRUCT 100/FT REPLACEMENT BULKHEAD
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Tvpe Name
Mailinq Addrpcc
t;itylStatelZip
856 889 4337
Telephone Numberl email address
Date
*Valid for one calendar year after signature*
(Adjacent Pro rty O er Information)
Print or Type Name
i L We 1,,6 St
Mailina Addn6se
City/State/Zip
s — j f- •� L -:z. i
Telephone Numberl email address
9-36
Date*
(Revised Aug. 2014)

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